NQF Issues Guidance on Measuring Health IT-Related Safety Issues

The National Quality Forum (NQF) issued a new report providing a framework for health IT stakeholders to consider the effect of health IT on patient safety and prioritizes key measurement areas.

The use of health IT has introduced new patient safety challenges into the healthcare system, according to NQF, a Washington, D.C.-based non-profit organization, and potential health IT patient safety risks could relate to IT design, use or implementation. Risks to patient safety could include flawed implementation strategies that may result in clinicians circumventing TI safety features, alert fatigue and design flaws that can result in the recording of inaccurate patient information.

NQF convened a committee of 22 health IT and safety experts to address patient safety issues related to the use of health IT. According to a NQF announcement about the 99-page report, the committee recommends that patient safety measures consider these three high-level concepts:

Safe health IT – to ensure that health IT is accessible and usable on demand by all members of a care team and that health IT data are complete, accurate, secure, and protected

Using health IT safely – to ensure that features and functionality are effective, efficient, and implemented as intended; that there are structures, processes, and procedures in place to ensure safety and safe use of health IT; and that there are effective mechanisms to monitor, detect, and report on the safety and safe use of health IT

Improving patient safety – to ensure that health IT is leveraged to reduce patient harm and improve the safety of patient care and enables meaningful and effective patient engagement.

“Identifying patient safety risks associated with use of health IT is foundational to reap the benefits of IT to improve patient care, and all healthcare and health IT stakeholders have a shared responsibility to address these risks,” Hardeep Singh, M.D., chief of the Health Policy, Quality & Informatics Program at the Center for Innovations in Quality, Effectiveness, and Safety based at the Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston and also the chair for the NQF committee, said in a statement. “Our recommendations prioritize risk areas and build a strong scientific foundation to advance measurement and improvement of patient safety in this area.”

“With the rapid adoption of health IT across the continuum of care, we must consider the potential impact on patient safety to ensure that this critically important tool is a positive and transformational force for change,” Helen Burstin, M.D., chief scientific officer of NQF, said.

In addition, the committee identified nine key measurement areas for health IT safety—clinical decision support; system interoperability; patient identification; user-centered design and use of testing, evaluation and simulation to promote safety across the health IT lifecycle; system downtime (data availability); feedback and information sharing; use of health IT to facilitate timely and high-quality documentation; patient engagement and health IT-focused risk management infrastructure.

In its announcement about the report, NQF called attention specifically to addressing the safety of tools that help clinicians make decisions about patient care, such as clinical decision support (CDS), as well as the ability of health IT systems to exchange information.

NQF noted that “poorly designed or configured CDS can threaten patient safety, such as when clinicians experience alert fatigue.” The committee recommend in the report that CDS measurement address “the appropriateness and timing of alerts, the appropriateness of clinicians’ responses to those alerts, and the monitoring of CDS content to ensure that it remains useful, clinically relevant, up-to-date, and free of errors.”

And, the NQF committee report also noted that the need for health IT systems to “seamlessly exchange patient data is increasingly important.”

“But many EHRs still are not interoperable, potentially leading to failures in communicating important patient information (such as test results) and delays in treatment. The report suggests that measurement of interoperability could assess whether systems have the ability to communicate and exchange specific types of data and how often diagnostic test results are unavailable when needed,” NQF stated.

The report authors note that the goal of the project is to provide “guidance and direction on priorities related to measurement of health IT safety” and the potential measurement concepts identified in the report are suggested areas for future work and “should not be considered NQF-endorsed measures, nor should they be taken as fully developed measures to be implemented as presented.”

“By identifying some of the highest-priority areas, this report may serve as a basis for future efforts to develop measures that can be incorporated throughout the HIT lifecycle as part of an iterative development process. Measurement based on iterative and continuous learning will successfully inform future HIT quality and safety improvement efforts, including in emerging areas such as improving diagnosis,” the report authors stated.

The report authors also noted that advancing the safety and safe use of HIT “will require stakeholders to share responsibility and accountability for patient safety” and “this may require a substantial cultural shift for the many groups involved in the development and use of HIT systems.”

While health IT innovation is moving at an incredibly fast pace, the report authors note that the changing landscape “offers a significant opportunity to ensure that patient safety considerations are incorporated into all phases of the health IT lifecycle.”

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